Contributors This research was conceived and designed by H Pattison, J Daniels, A Furmston and AK Ewer. Data were collected and collated
by A Furmston and A Bhoyar and analysed and interpreted by R Powell, L Middleton and H Pattison. All authors have critically
commented on drafts of this paper and approved the final version.

Received 20 October 2011

Accepted 20 February 2012

Published Online First 18 May 2012

Abstract

Background Introducing neonatal screening procedures may not be readily accepted by parents and may increase anxiety. The acceptability
of pulse oximetry screening to parents has not been previously reported.

Objective To assess maternal acceptability of pulse oximetry screening for congenital heart defects and to identify factors predictive
of participation in screening.

Design and setting A questionnaire was completed by a cross-sectional sample of mothers whose babies were recruited into the PulseOx Study which
investigated the test accuracy of pulse oximetry screening.

Participants A total of 119 mothers of babies with false-positive (FP) results, 15 with true-positive and 679 with true-negative results
following screening.

Main outcome measures Questionnaires included measures of satisfaction with screening, anxiety, depression and perceptions of test results.

Results Participants were predominantly satisfied with screening. The anxiety of mothers given FP results was not significantly higher
than that of mothers given true-negative results (median score 32.7 vs 30.0, p=0.09). White British/Irish mothers were more
likely to participate in screening, with a decline rate of 5%; other ethnic groups were more likely to decline with the largest
increase in declining being for Black African mothers (21%, OR 4.6, 95% CI 3.8 to 5.5). White British mothers were also less
anxious (p<0.001) and more satisfied (p<0.001) than those of other ethnicities

Conclusions Pulse oximetry screening was acceptable to mothers and FP results were not found to increase anxiety. Factors leading to
differences in participation and satisfaction across ethnic groups need to be identified so that staff can support parents
appropriately.

Footnotes

Collaborators Members of the PulseOx Study Group: K S Khan and S Thangaratinam (Barts and the London School of Medicine), J J Deeks (University
of Birmingham), A M Tonks, West Midlands Perinatal Institute, UK; S Hooper and S Caranci Birmingham Women's NHS Foundation
Trust UK; P Satodia and C Hill-Evans, University Hospitals Coventry and Warwickshire NHS Trust, UK; S Deshpande, S Mehta and
S Ward, The Shrewsbury and Telford Hospital NHS Trust, UK; B Kumaratne and K Cheshire, The Royal Wolverhampton Hospitals NHS
Trust, UK; S Sivakumar and M King, Sandwell and West Birmingham Hospitals NHS Trust, UK; R Mupanemunda and D Mellers, Heart
of England NHS Foundation Trust, UK. The PulseOx Study was coordinated by Birmingham Clinical Trials Unit at the University
of Birmingham and we acknowledge the work of all the staff involved in the study, especially Leanne Fulcher, who was the data
manager, and Edward Tyler who designed and developed the study database. We thank all the community and hospital midwives,
midwifery assistants and nursing staff who conducted recruitment and screening. We are particularly grateful to all the women
who participated.